Frustrated with new job

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Specializes in LTC.

I recently took on a role at a new AL/IL facility as the administrator. This place is sooooo disorganized. Staffing is out of control. The owners want me to staff at levels that are not conducive to giving good care. They want an unrealistic amount of work out of the CNAs and want me to beat a budget that was in place a year ago when they facility had 20 less residents. They want the CNAs to do all the housekeeping. There is no med tech (the CNAs just give out meds willy nilly) They won't let me staff a med tech for each shift as her sole responsibility. I am pretty sure night shift is sleeping instead of checking in the residents. No one is on a toileting schedule. Residents that are incontinent are wet all the time. Each shift blames the prior. Residents that wet their beds are having their wet beds made up and the families are finding this!The activity director is a royal pain that doesn't want to do anything and acts like a martyr. The receptionist is the biggest gossip and keeps things stirred up with the staff, residents, and families. Gossip is rampant with all the staff. The CNAs tell the families things like, 'I noticed your dad didn't get a shower last night even though he was supposed to' or 'I don't think your mom is getting her meds like she should'. The place is a mess!

I really want to turn this place around and make it work, but where do I start? I am tired of getting yelled at by family members for things that the carestaff aren't doing.

The changes I have made so far are:

1. Assigning one CNA to the meds and the others cover her assignment while she is doing her med pass.

2. Working the budget out to cover a FT housekeeper to clean.

3. Giving the CNAs a detailed assignment sheet of who they have and what they are expected to do.

My question is, What else can I do to turn this place around and how do I hold the CNAs accountable for not doing things when they have a detailed assignment AND when they blame wet beds and pullups on another shift?

Thanks!

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Write down a complete list. Then prioritize. Take a number of things to address, say five or seven at a time. Come up with a plan. Present to your affected employees, then dig in. What is the job market like in your area? If you have to dismiss anyone can you get a replacement? Start a disciplinary program for those who are not changing their assigned residents and are sleeping on night shift. Make raids on night shift. You have the keys, check up on them. If you find someone sleeping, fire them on the spot. Only one general warning to all CNAs about leaving their residents in urine or feces. Spot check and discipline. When they see that you mean business, things will change. You might have to fire one or two, but you shouldn't have to fire a third person. While you are at it, try to come up with positive reinforcement. If you see an outstanding employee, give that person a raise, even if only .10 an hour. That's a start. I forgot to add. Let yourself be seen. At all hours, throughout the facility. Find all the hiding places. The employees will see that there really is no place to hide anymore. Good luck.

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Specializes in Psychiatry, Case Management, also OR/OB.

See previous post. Nuff said!!

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Specializes in A myriad of specialties.
write down a complete list. then prioritize. take a number of things to address, say five or seven at a time. come up with a plan. present to your affected employees, then dig in. what is the job market like in your area? if you have to dismiss anyone can you get a replacement? start a disciplinary program for those who are not changing their assigned residents and are sleeping on night shift. make raids on night shift. you have the keys, check up on them. if you find someone sleeping, fire them on the spot. only one general warning to all cnas about leaving their residents in urine or feces. spot check and discipline. when they see that you mean business, things will change. you might have to fire one or two, but you shouldn't have to fire a third person. while you are at it, try to come up with positive reinforcement. if you see an outstanding employee, give that person a raise, even if only .10 an hour. that's a start. i forgot to add. let yourself be seen. at all hours, throughout the facility. find all the hiding places. the employees will see that there really is no place to hide anymore. good luck.

many good points, caliotter! i would also suggest that the op make "walking rounds" a priority. by this i mean at every shift change, the cnas from each shift go together and do rounds(checking all pts and thoroughly checking the incontinent ones) so that both shifts know the condition of the patients as they are found. that should cut down on the "shift wars" to some extent. also, make it a point in some meeting that the cnas realize that leaving pts in urine or feces is neglect; that speaking badly of one shift is slander and that neither will be tolerated.

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Yes, I agree. Start emphasizing the power of the written warning. Written warnings can be used for multiple purposes, to include sending to the board for board disciplinary proceedings if need be. Let everyone know that you intend to see that the residents are not abused and will send paperwork to the board in addition to firing someone. There is no excuse for neglecting the residents. Do you have licensed nurses? Where are they in all of this? They need to get in the loop or you will need to write them up too. But have a separate meeting with them and chew them out separately.

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Specializes in Mental and Behavioral Health.

There are an awful lot of good people out of work right now. This is fortunate for you. You should be able to put together a dream team, once you clear out the deadbeats.

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Specializes in Case management, UM, AL, psych, CD.

The company you work for isn't Assited Living Concepts is it???

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Specializes in Ortho, Case Management, blabla.
at every shift change, the cnas from each shift go together and do rounds(checking all pts and thoroughly checking the incontinent ones) so that both shifts know the condition of the patients as they are found.

the facility i used to work at as a cna did this at one point, and it only made things worse. it is an interesting concept, but when the cnas are already being overworked and barely getting out on time the last thing they need is to be forced to round together. it isn't practical and will more than likely create more problems than it solves.

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Specializes in A myriad of specialties.
the facility i used to work at as a cna did this at one point, and it only made things worse. it is an interesting concept, but when the cnas are already being overworked and barely getting out on time the last thing they need is to be forced to round together. it isn't practical and will more than likely create more problems than it solves.

"walking rounds" is practical, works very well, and created fewer problems in our hospital which is why i suggested it. rounds have to be done anyway so why not together? doing rounds together is not an added task so is not overworking current staff by any means. patient care is a team effort. neither shift is putting in overtime to do the rounds; time involved in the rounds is part of the shift. i've been doing this for many years; i know what works.

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Specializes in Geriatrics.

All the facilities I've ever worked in, both shifts made walking rounds together. The shift coming on had to sign their name that they "accepted" the hall in current condition. It definitely makes it easier on the charge nurse too to not hear one shift snipe at the other over someone being wet etc. They didn't just check the residents, they toileted the ones that could during rounds as well. They also signed and dated the Attends of everyone that wore them.

Blessings, Michelle

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Specializes in LTC, hospitals and correctional settings.

I feel for you! About a million (or 18) years ago, I worked as an LPN in a AL/IL facility that had specific criteria for dealing with incontinence. If a potential resident was incont. they had to either be able to self manage their "depends" or pay for someone else to do it (read hire private duty care). They had to be ambulatory with the only assistance being a walker or cane. They were NOT to be lifted in any way at any time (OSHA regs I think). The AL area was a seperate but connected part of the building with their own dining room and the CNA's were 90% med tech that gave out only scheduled meds from cards, NEVER PRN's. The CNA/Med techs were responsible for doing the meds, LIGHT housekeeping (emptying trash, making beds, etc.) reminding residents to go to meals, serving the meals and helping with the meals (opening jelly packets, cutting meat, getting resisdents seconds, NOT FEEDING!!) and running the activities in the AL unit. The remainder of the building was IL and they were to need NO ADL's AT ALL!!! An RN or LPN was on duty 24/7 for EMERGENCIES ONLY and to supervise the CNA's in AL. It sounds like your company is running a LTC facility, NOT a AL/IL facility and they are calling it that to skirt around the regulations regarding LTC. PLEASE, for the sake of your license, find out what the criteria for admitting are. If you are the only license in the building, it's all you when the facal material hits the ventilation system. I also suggest you look into your specific states regulation regarding AL/IL facilities to make sure your employer is in compliance. I doubt you will find out anything good. Please keep us updated, very curious to know what you find out.

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Make a chart for each resident and post by their bedroom doors..be specific on times for bed checks, restroom, showers, linen wash, meds administered, etc. Have the CNAs sign in ink when the task is accomplished. Then "pop" in during those times...if they are not assisting another resident at those times they are suppose to be with Jane Doe and watching tv instead, write them up.

As for gossip: call a staff meeting and specifically spell out the rules. Make them sign a document after the meeting stating they have been informed of these rules and put in their employee file. Gossip will NOT be tollerated, there is no blame game here anymore...this is a team. If you cannot find something positive to say to a residents family member, find something to busy yourself with and direct them to contact me.

Remind them that it is the residents that make their paychecks. Should you start to lose residents, there will be no need for some of the staff.

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